(341) Conflicting Trends in ECMO-Associated Neurologic Injury: Are We Improving?

Introduction: Neurologic injury associated with extracorporeal membrane oxygenation (ECMO) has a reported incidence of 15-35% without a clear understanding of trends with the evolution of ECMO management. This study characterizes trends in acute neurologic injury associated with ECMO and post-decannulation radiographic abnormalities

Methods: IRB approved single-center retrospective study of pediatric ECMO from 2014-2023. Patients with pre-existing neurologic conditions or ECMO support for under 12 hours were excluded. Collected variables included demographics, diagnoses, cannulation strategies, and neurologic & survival outcomes

Results: Cohort included 94 patients with median age of 3 days (IQR 1, 164). Most had venoarterial cannulation (n=83, 88%). Diagnoses included persistent pulmonary hypertension (n=47, 50%), acute respiratory failure (n=18, 19%), diaphragmatic hernia (n=11, 12%), circulatory failure (n=10, 11%), and sepsis (n=8, 8%). 81% (n=76) survived to decannulation and 72% (n=68) survived to hospital discharge. Acute neurologic injury while on ECMO defined as seizures or cranial ultrasound detection of hemorrhage or ischemia was diagnosed in 21% (n=20) of patients with 30% incidence in 2014-2018 and 14% in 2019-2023. Diagnoses included hemorrhage (n=14, 70%), ischemia (n=6, 30%), and seizure (n=5, 25%). Post-ECMO MRI was obtained in 70% (n=54) of patients who survived decannulation: 55% (18/33) in 2014-2018 and 84% (36/43) in 2019-2023. MRI-detected lesions in patients without acute neurologic injury while on ECMO were present in 46% of patients (n=25); with higher incidence noted over time: 58%, n=21 in 2019-2023 v. 20%, n=4 in 2014-2018

Conclusions: Acute neurologic injuries associated with ECMO at our center are consistent with previous reports, though we observed a downward trend over recent years. The incidence of post-decannulation, clinically unrecognized brain MRI abnormalities is higher than clinically evident abnormalities and appears to have increased over time, possibly due to advanced neuroimaging technique. Conflicting trends in acute neurologic injury while on ECMO and MRI-detected intracranial abnormalities detected post-decannulation should be interpreted with caution and emphasize the importance of longitudinal follow-up to determine if contemporary care is improving outcomes